April 2012

COMBATING HIGH DEDUCTIBLE HEALTH PLANS

As mentioned a few weeks ago, we are seeing a significant increase in the # of HIGH deductible insurance plans – as high as $5,000 per year – with the resulting higher patient balances. Patients are taking longer to pay and even refusing to pay their deductible. Finding a way to avoid sending them to collections is important for your cash flow.

We are looking at various products to help you address this before it becomes a cash flow crisis. We think it may be better for you to receive 97-98% of your payment on the day of service, than 100% of nothing – or a long delay in getting paid. Practices are essentially becoming a bank/ loan officer for these patients!

Just wanted to keep you appraised of progress. When we attended our billing software’s Users Meeting last month, I met with several vendors. I am looking for something that is beyond simple credit cards, so that the increasing #’s of high deductible plans can be addressed in a more effective way with broader options – credit cards, electronic checks, HAS cards, and the occasional first born child!

So far several vendors meet the above criteria and offer:
*For those using our Appointment system, integration into the Hpac Appt. System to avoid double entry and ease of use to check eligibility and storage of that data.
*Credit cards (deposit direct to the client, and a report to CPB). Also sets up payment plans to automatically pay each month.
*Eligibility, including co-pay amount, deductible, amount of deductible already met. This
*Electronic patient statements – which can also direct patients to the patient portal for electronic payment.
*Patient portal (numerous benefits)

So far I have looked at 3 vendors with pretty good products & will look at one more.

We are still on track to select 1-2 to recommend to you by the end of April, tho hopefully a little sooner. You would have a great deal of flexibility as the vendors all seem to have an ala carte approach, as well as options within what you choose use. Or you could not use it at all.

Feel free to call with any questions.

THERAPY CAP AUDITS

As part of the Middle Class Tax Relief and Job Creation Act of 2012 (Job Creation Act) signed into law by President Obama on Wednesday, February 22, 2012, Section 3005 also mandates that Medicare perform manual medical review of therapy services furnished beginning on October 1, 2012, for which an exception was requested when the beneficiary has reached a dollar aggregate threshold amount of $3,700 for therapy services, including OPD therapy services, for a year. There are two separate $3,700 aggregate annual thresholds: (1) physical therapy and speech-language pathology services, and (2) occupational therapy services. These audits will be for charges being processed today so please be certain that these patients properly meet the Exception requirements.

ICD-10

CMS announced that they are delaying implementation of ICD-10 from the October 1, 2013 date. When the new date is announced, we will again begin to address it.


CHECKING MEDICARE PATIENTS FOR PREVIOUS ANNUAL WELL VISITS (AWV)

We have called Medicare to ask how a provider would know if a new patient had received other AWV services from another provider previously. We were told you can call Medicare and ask if patient received AWV services before. We have found some reps are more helpful than others.

INDUSTRY STATISTICS

One-sixth of the US economy is devoted to Healthcare Industry Statistics healthcare spending
• $2.6 trillion spent each year on healthcare in the US.
• $800 billion a year goes to care that is wasteful, redundant, or inefficient.
• On the current course, health expenditures will increase 6.1 percent per year on average over the next decade.
• Over $160 billion is spent on administration that does not go toward paying for health care.
• One of every seven claims is denied initially -- about 200 million claims out of the 1.4 billion submitted yearly.
• On average, national health insurers paid physicians in 33 days and denied 9.2 percent of claims.
• Administrative costs stemming from interactions between providers and insurers are estimated to total $31 billion a year.
• On average, a full 60% of a provider’s practice revenues is overhead.
• Commercial insurance companies have an error rate of almost 20% due to errors in claims processing, wasting almost $17 billion annually.
• 1 in 5 claims are not sent electronically.
• Almost 25% of all claims received no payment at all.
• The top reason claims are denied is patient eligibility. Other top reasons are missing information and services not covered.
• A 20% error rate in processing claims represents $3.6 million in erroneous claims payments, and an added $1.5 billion in unnecessary administrative costs.

March 2012

COMBATING HIGH DEDUCTIBLE HEALTH PLANS

If you haven’t already noticed, high deductible health plans are here - estimated at 16% in 2011 !

And the news is generally not good. Horizon has at least 1 plan that does not even allow providers to collect payment for the co-pay or deductible on the date of service (DOS)! Some insurers have also applied Well Visits to the deductible. Of course many patients are slow to pay out of their own pocket, don’t pay at all, or want payment plans spaced out over many months – all of which adversely affect your cash flow.

Important components of a strong office financial policy:

1. When making the appointment for new patients obtain their demographics and insurance information (including subscriber name & DOB, policy & group #’s). If it is an existing patient, ask if the insurance has changed.
2. Check eligibility & benefits at least 1 day before the pt will be seen. Verify their co-pay, annual deductible, and the amount of the deductible met.
3. Contact each patient 1-2 days prior to remind them of their appointment.
4. Always collect money at check-in and never at check-out. Make that your policy.
5. If a high dollar procedure for a patient with a high deductible plan is to be performed in the office, determine patient responsibility. Document all of this in the CPB appointment system so money can be collected at check-in. The minimum collected should be the patient’s copay. It is better to refund overpayments than not get paid.
6. Clients using the CPB appointment system can run a report showing all patients with patient balances. That amount also prints on the Charge Form when you print it.
7. Each practice must have a clear policy on collecting co-pays and previous balances on the account at each visit. If the balance is large, how much is an acceptable payment if it cannot be paid in full? The key to this policy is to reschedule the appointment, even when the patient showed up for the visit, if appropriate payment is not made so long as it is medically, ethically and legally permissible.
8. If the practice is not using the CPB Appointment System, it is available at no cost. Even if you do not want to use it for appointments, you can still check patient balances.
9. As part of our Month-end Reports, we include the amount collected on the date of service. We track this each month for each client.

With this increase in high deductible plans, we are searching for a tool that will allow the patient to authorize automatic withdrawals from their checking account each month or from their credit card. This way the patient is committed to payment.

Steps to avoid losing money:• Accept credit & debit cards. Paying 2% to the credit card company is better than losing the other 98%.

We are also working some other options and hope to report a comprehensive solution within 2-3 months.

A FEW HELPFUL HINTS TO GET PAID

It is very important for offices to check each patient’s insurance each time they are seen. Insurance plans are written with anniversary dates of either the 1st or 15th – so insurance can change or be lost – on those dates. Clients using the CPB appointment system and who scan insurance cards into it can simply view the insurance card from the last visit, & scan the new card into the software, if needed. Without correct insurance information, you will not be paid.
NJ Medicaid benefits are month-to-month & should be verified with Medicaid on EVERY visit before the patient is seen. The card they carry is not an insurance card and does not insure benefits. Coverage needs to be verified before seeing the provider. If the Medicaid system says they are not covered, you should seriously consider collecting payment (Cash) before the patient is seen. You may want to begin collecting patient email addresses! Current technology allows patient statements to be handled via secure email and costs about half of the cost to mail a paper statement.

MEDICARE REFUNDS

On Tue Feb 14, CMS proposed that providers and suppliers must report and return self-identified overpayments within 60 days of the incorrect payment being identified.

EHR’s

Good news! If you have not implemented a Complete Certified EHR yet:• 2012 is the last year to receive full funding under the Medicare program. To do so, you must implement soon so you can achieve 90 days of “Meaningful Use” by the end of the year.• If you implement this year, you can also use the current Stage 1 guidelines for 2013 and will not have to meet Stage 2 requirements until 2014Final Stage 2 guidelines are expected to be released later this year.

ICD-10

CMS has now announced that the October 1, 2013 date will be postponed but have not indicated for how long.

Now that 5010 is safely behind us, we will begin focusing on the transition to and implementation of ICD-10 coding which is effective on October 1, 2013. While that sounds like a far off date, the ICD-10 codes are very different – yet also similar – than ICD-9. For all of our clients that only affects diagnosis codes – not CPT codes. Over the next 20 months we will include a brief paragraph each month to help bring you up to speed so we have another smooth transition.

CHECKING MEDICARE PATIENTS FOR PREVIOUS ANNUAL WELL VISITS

I just called Medicare & asked how a provider would know if a new patient had received G0438 services from another provider previously. I was told we can call Medicare’s Representative Dept and ask if patient received G0438 before.

Note -They can only answer yes or no and cannot give any details as to when G0438 was rendered or by which provider.

Medicare’s new phone system was a bit confusing. The prompts are as follows:
Part BClaim-related QuestionsClaim StatusSay “Operator” after listening to claim status
It seems kind of silly to listen to claim status messages such as “claim currently in process” or “no record of claim” before you can opt out to an operator. However, per another rep, this is the only way.

February 2012

CHECKING INSURANCE CARDS EVERY VISIT

It is very important for offices to check each patient’s insurance each time they are seen. Insurance plans are written with anniversary dates of either the 1st or 15th – so insurance can change or be lost – on those dates. Clients using the appointment system and who scan insurance cards into it can simply view the insurance card from the last visit & scan the new card into the software, if needed. Without correct insurance information, you will not be paid.
NJ Medicaid benefits are month-to-month & should be verified with Medicaid on EVERY visit before the patient is seen. The card they carry is not an insurance card and does not insure benefits. If the Medicaid system says they are not covered, you should seriously consider collecting payment before the patient is seen.

MEDICARE ELECTRONIC HEALTH RECORD (EHR) INCENTIVE PROGRAM

If you plan to participate in the Medicare EHR Incentive program, you must start in 2012 in order to be able to collect the full $44,000. Not starting until 2013 decreases the total amount to $39,000 and not starting until 2014 decreases it to $24,000. We strongly recommend getting started ASAP as it can take time to install the program, learn to use it “meaningfully,” & begin billing with the proper code to document the use with Medicare (has to be done at the same time charges are billed – cannot be done later). Billing the special code is how Medicare tracks the eligible charges. You need a minimum of 90 days plus $24,000 of Allowed charges in order to qualify for the $18,000 first year payment. “Ramp up” for an EMR is usually 60-90 days once you “go live” plus 4-8 weeks from contract signature to ‘go live” depending on the EHR vendor’s backlog.

If you have questions, feel free to call Rich.

GARDASIL

United Healthcare/Oxford Will Start Covering Gardasil for Males Age 9-26 On February 1, 2012.

NEW MEDICARE ABN FORM

In March 2011, CMS revised the Advanced Beneficiary Notice of Noncoverage (ABN) form used by healthcare professionals, including physicians, when they expect Medicare will deny payment. The mandatory date to use this revised form is January 1, 2012. Old forms used on or after January 1, 2012, are considered invalid. As mentioned in Client Bulletins earlier this year, if you are using a form prepared by CPB please let us know so it can be updated to the new form. Using the old form means it will not be considered valid.

ELECTRONIC CLAIMS AND PAYMENTS – 5010 FORMAT

On January 1, 2012 the medical billing industry must begin submitting claims and applying payments using the 5010 version. CPB has been submitting all electronic claims in the 5010 format since mid-December and have not seen any significant problems. However, Medicare has had problems returning complete payment information & we are working thru those issues.

OFFICE-BASED PROVIDERS (PHYSICIAN AND NON-PHYSICIAN) COMBATING HIGH DEDUCTIBLE HEALTH PLANS

Important components of a strong office financial policy:

1. Always collect money at check-in and never at check-out.

2. Be sure to verify insurance before the visit. Be sure to identify either the co-pay amount or a co-insurance/deductible status. If a high dollar procedure for a patient with a high deductible plan is to be performed in the office, determine patient responsibility. Document all of this in the system so money can be collected at check-in. The minimum collected should be your cost

3. Clients using the CPB Appointment system can run a report showing all patients with patient balances. That amount also prints on the Charge Form when you print it.

4. Each practice must have a clear policy on collecting co-pays and balances on the account at each visit. If the balance is large, how much is an acceptable payment if it cannot be paid in full? The key to this policy is to reschedule the appointment, even when the patient showed up for the visit, if appropriate payment is not made so long as it is medically, ethically and legally permissible.

5. If the practice is not using the CPB Appointment System, it is available at no cost. Even if you do not want to use it for appointments, you can still check patient balances.

6. As part of our Month-end Reports, we include the amount collected on the date of service. We track this each month for each client.

7. With the increase in high deductible plans (estimated at 16% in 2011), we are searching for a tool that will allow the patient to authorize automatic withdrawals from their checking account each month or from their credit card. This way the patient is committed to payment.

ICD-10

Now that 5010 is safely behind us, we will begin focusing on the transition to and implementation of ICD-10 coding which is effective on October 1, 2013. While that sounds like a far off date, the ICD-10 codes are very different – yet also similar – than ICD-9. For all of our clients that only affects diagnosis codes – not CPT codes. Over the next 20 months we will include a brief paragraph each month to help bring you up to speed so we have another smooth transition.

eRx for 2012

In order to avoid a penalty in 2013, you must report code G8553 at least 10 times on eligible visits prior to June 30, 2012 and 25 times prior to 12/31/12. An eligible visit is 1) a visit by a patient who has Medicare Part B, 2) an encounter billed as an E/M code, and 3) one that a prescription was submitted electronically (and was associated with the visit).